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Ontario Improving Care for Patients with Complex Conditions

Community Initiatives Focus on Coordinated Care, Reducing Hospital Admissions

January 12, 2015  

Ontario is working together with local health care teams in West Toronto to provide better, personalized care for seniors and patients with complex medical conditions.

By continuing to move forward with its plan to provide more coordinated care for patients through greater collaboration between different health care providers two initiatives are being announced in West Toronto today. This work is focused on West Toronto’s highest needs patients - the five per cent of patients with the greatest medical needs, often with multiple, complex conditions, and who contribute to two-thirds of all of Ontario’s health care dollars.

The Central West Toronto Health Link and the West Toronto Health Link provide patients with better care through individual care plans and co-ordinated support from a tightly knit team of providers that can include doctors, nurses, specialists, hospitals, home care, long-term care and community agencies. These teams work together to develop solutions that address each patient’s specific needs.

Providing better care for seniors and patients with complex conditions supports Ontario’s Action Plan for Health Care. It is also part of the Ontario government's four part economic plan to build Ontario up by investing in people’s talent and skills, building new public infrastructure like roads and transit, creating a dynamic, supportive environment where business thrives and building a secure savings plan so everyone can afford to retire.



"Laura Albanese, MPP, York South Weston, with Stacey Daub, CEO, Toronto Central CCAC, at the West Toronto Health Link and Central West Toronto Health Link announcement." 





"Ontario continues to integrate and improve access to health care — making health care more accessible and providing the kind of high needs continuous care in their homes and communities that works best for patients. We’re focusing on ways to provide seniors and patients with high needs with continuous care in their homes and prevent avoidable hospital admissions."

— Dr. Eric Hoskins, Minister of Health and Long-Term Care

"I’m glad to see health providers in West Toronto working together to improve the patient outcomes of those who need it the most. These new initiatives will make it easier for seniors with complex conditions to get the care they need."

— Laura Albanese, MPP, York South Weston

"We are pleased to have a key role in this collaborative approach to improving care and services for people residing within the Central West Health Link. We now have an opportunity to facilitate coordination at a local level by creating strong partnerships with primary care, hospitals, homecare, and community."

— Mohamed Badsha, Lead, Central West Health Link, Chief Operating Officer, Reconnect Mental Health Services

"We are thrilled to have such an amazing opportunity to work directly with patients, residents and health care workers to develop new ways of caring for people with the most complex health care needs. Developing local solutions, building on their strengths of the West Toronto community will have long lasting benefits for patients and the health care system at large"

— Stacey Daub, CEO, Toronto Central CCAC – lead organization for West Toronto Health Link


  • Health Links have expanded to 67 in communities across Ontario.
  • A study found that 75 per cent of seniors with complex conditions who are discharged from the hospital receive care from six or more doctors.
  • In order to establish a Health Link, strong representation from local primary care providers and the Community Care Access Centre is required.



About the CCAC

Community Care Access Centres (CCACs) connect people across Ontario with quality in‐home and community‐based health care. CCACs provide information, access to qualified care providers and community‐based services to help people come home from hospital or live independently at home.